Help Please - Rotator Cuff Op in 4 weeks

Hi All

First time posting here, any help really appreciated please.

I am having an op on 12 Jan 2010 for full thickness (moderate size) supraspinatus tear ( acute - fell over running 5 months ago) , arthriscopic + SAD.

I am a 54 year old female triathlete and runner , and since having a corisone injection by my consultant 2 mths ago have been 98% pain free and 100% ROM. However 2 consultants say that this reprieve is only temporary and the op. is a must.

I am extremely fit and well physically but absolutely terrified regarding the outcome of this op. Sport is a major part of my life.

2 questions really:

1. Following the op. what do people think about conservative first 6 weeks i.e. passive in a sling with NO PHYSIO ( this is what my consultant favours ) !! or alternatively more proactive physio starting at 2 weeks - which is what I favour and so do some specialists !!

2. As a "gym"/sport obsessive, what lower body/core exercise can anyone recommend immediately post op. Recumberant bike has been suggested, anything else lower body where I can maintain my aerobic capacity. Anything strength lower body/core.

Many thanks, I'm pretty unhappy and desperate at the moment and i have'nt even had the op yet. :(

I am 13 weeks post op and am about 50% of where I was before the surgery. I am a 55 yo male in good shape, and work very hard at my therapy. Everyone I talk to thinks the surgery is worth it, but I am not seeing it yet. I'm just beginning to look around to find out if Im "normal".
Keep in touch.. I'll be glad to share my experience.
Paul
Additional Comment I forgot:
I was on my treadmill on day 3.. had no problem maintaining speed but did not want to over do and start to get my sling (friend) soaked with sweat. You will know what hurts your shoulder... it will tell you very quickly.

Many thanks for your response and apologies for my delay in replying.


My op is on Tuesday !!!

How did you manage to get back on a treadmill in 3 days. My consultant has told me complete immobility in a sling for 6 weeks. I asked about running on a treadmill and she said the shoulder would move around too much ? Any suggestions how to keep my aerobic capacity whilst arm in a sling, I can only think of a recumberant bike in the gym?

Thanks

I was in therapy on day 2... with passive movement. Total immobilization for 6 weeks will freeze the shoulder for sure. You will know what you can do, your shoulder will tell you. I am at 14 weeks and am close to 60% quickly getting my strength back. Get on the treadmill, and do what you feel you can.

Hi

Many thanks again for your response. Unfortunately it seems that my surgeon ( who is apparently excellent) likes a very CONSERVATIVE physio protocol. I have had second opinions from other surgeons re: the physio but all seem to think that the benefits of starting any movement prior to the six weeks may be outwayed by the possibility of disrupting the tendon/bone "anchor" attachment/sutures! Of course the problem is that none of the surgeons are athletes!

They state that if the repair "fails" due to starting movement too soon, it will be very difficult to re-attach.

Dont really know what to do for the best ?

It's incredible to me the variance of opinion on what you would think would be long time tested actions vs results. I can only speak for myself and my colleagues of the benefit of passive movement. There is a very controlled progression of passive movement in thereapy and 24 X 7 sling for the 1st 6 weeks. You do not start working the repair until week 7 through week 12. Post week 12 is strength training the operative repair. Naturally you have to follow your surgeons regiment. Please keep me up to date your progress. You may recover faster than I did.
Good Luck
Paul

The regime can vary greatly depending on what the surgeon finds when he's in there, his particular experiance and there are more or less "conservative" surgeons. Here in Switzerland the "mobilising " afterwards is partial but the arm can be in a Gilchrist closed in sling or a light sling afterwards or a splint /cushion in some abduction or or. It's therefore not always possible to say what you will have exactly. One thing here is sure that there is to be no active abduction during the first 6 weeks because of the danger of pulling out the anchor!! Your arm will not be the person to tell you what you can do straight away post op. You might have more or less pain and you will need medication to control it.
"Physio" from day one does not indicate GO FOR IT MOVE but a sensible, based on healing times for the tissue assisted or passive only assistance to maintaining movement. Neither does physio from day one mean so much range of movement as possible so early as possible. Here, the allowed movement in the allowed direction is specified by the surgeon. Here, from 7 weeks on the movement is more active. Car driving not advised before 6 weeks; back to work for office type jobs 3-6 weeks. Hard physical jobs often 6 months. Rehab goes, depending on type of injury, repair and patient from 3-6 months. You will be at the 3 end if you are fit and young and do the rehab accordingly. That means you may start sport specific training then (at 3 months), not that you are already finished with it! You are a while since the initial injury and have probably adopted patterns of shoulder movement that are not optimal and it's extremely important to optimise your shoulder blade position/stabilisation then a so called centering of your glenohumeral joint. Failing to do this correctly will result in possible problems later like an impingement of the humerus head on the structures above it. Ask your chosen surgeon about his rehab regimes as to what comes when. We are lucky here to have reasonable post op regimes online at the local hospital and enough downloads of patient information to be informed about the main issues before the op. You will probably not be so lucky but try and ask anyway. And ask "why's". "conservative" must not always be taken as negative. Or if your surgeon isn't decided on 100% yet ask around. Don't only compare other peoples shoulder experiences because injuries, repair jobs, healing times and the individual types of people make for different results. And apropo re-rupture: the tendon hangs on the threads post op joining it to muscle and before 12 weeks is not fully repaired/healed. Take one step at a time and I hope it goes well for you.

Hi Paul

Once again thanks. I now have a complete file of research papers on this subject and still worried!
The problem is I have just come back from 2 weeks triathlon training in the sun over Christmas and New Year and feel absolutely fantastic. I have 100% ROM in my shoulder, no pain just the occassional twinge. the problem is that I have now explained this to 3 independent surgeons and they all say that the pain will come back ( steroid injection 2 months ago) and its better to have the surgery whilst I'm fit and well.

When you ran on the treadmill in your sling did your shoulder not feel it? Even jogging I can't see how there would'nt be some impact on the shoulder?

I know I have to have the sling on for 23 x 7 for 6 weeks, do they then just take it off completely? Must feel strange?

many thanks for all response

theresa

Many thanks for this response.

I do understand exactly what you are saying, I just feel anxious that an apparent acute injury ( MRI scan confirms) that is giving me no pain or problems at the moment is now going to cause me to have invasive surgery. Having 100% ROM and spending the last 12 months doing intensive pilates to improve my overall athletic performance I'm really worried that I'm going to land up with a permanent "frozen " shoulder or the like!

I will be in an abduction sling with cushion.

I am very good at following "intense" physio protocols, my worry is I am fit but 55 years old and inactivity is not good for me physically or mentally.

The problem is that the surgeon adopts the same protocol with ALL her shoulder patients regardless of age as she feels that it has the best outcome. She admits that the most of her patients are elderely and certainly not runners .

I have asked lots of questions and had them well answered, the problem is if it doesn't work out, I go into an operation fit and well and come out with a problematic shoulder.

I walked on the treadmill, sorry to imply it was anything else. I also am 55 and I think your worries are sound but slightly overblown. The repair is universally agreed to take about 12 weeks for you body to solidly attach it to the bone. The 0 to 12 week period's activity is wildly debated. I had a 75% tear and like you I was functional, so I delayed it for 3 years because of your fears. That complicated my progress. I am convinced I will be 100% withing 6 months from OP. You are not the type to not work hard at rehab. You will do fine...
The 1st 6 weeks, sleep loss, being confined in a sling are a mental test, but worth it. Please keep me up on your progress. My right was my operative arm, I did swap my mouse hand to left, and now I'm can't switch back, I've become ambidextrous.

Thanks for that. Feeling more positive now, hurray.

Had my operation last Tuesday,extremely surprised to be told that I HAD NO TEAR IN MY SUPRASINATUS AT ALL!!!!
Although I was initially pleased that I would not be in an abduction sling with protracted long term physio, I then was no quite so happy as had I known there was no tear I would not have agreed to the operation at all.
The surgeon did find apparently chronic bursitis and bony spurs under the clavicle which were cleaned up (SAD) but nothing affecting any of the tendons.
I must admit that I cannot understand how I could be given following an MRI,a very confident diagnosis of "full thickness tear of the supraspinatus" when there was no tear at all.
I was very reluctant as I was completely pain free with 100% ROM to have the op. in the first place and was only persuaded due the the apparent seriousness of the injury combined with my active sporting lifestyle.
I had never had any shoulder problems in the past, and this all started in May following a fall out running causing pain in my shoulder.
I will certainly never trust the outcome/interpretation of an MRI scan in the future without having further diagnostic testing.
The good news is that I had excellent NHS care and NO post op pain or any need for painkillers! I was given a nerve block which took 12 hours to wear off ( arm in sling) , but 3 days post op, stiffness and discomfort are my only symptoms ( no sling) . I had good ROM although not 100% by any means 12 hours post op, I have started gentle physio as instructed and HOPEFULLY I SHOULD have 100% ROM back soon.

Glad to hear the good news.

Always stay fit and strong.. ;)

Always nice to hear good news and also to hear that the NHS is doing things right.

I am now 6 months post op and still in some pain, with only partial use of my shoulder. I did the 3 months PT, and continued my regiment religiously. I'mm 55 YO, so I'm sure that has something to do with it. Have and had full ROM since month 3. I'm going to call it 50 %. For example I could not even begin to start a lawn mower with it. It's a very slowwwww process!
I'm hoping to be 100% before social security kicks in :-) .